Tag Archives: Neonatal deaths

Three new tools from the World Health Organization

On 16 August, 2016 the World Health Organization (WHO) launched three new tools to count and review stillbirths, and maternal and neonatal deaths!

Browse the standardised system to capture and classify stillbirths and neonatal deaths in the WHO Application of the International Classification of Disease-10 to deaths during the perinatal period (ICD-PM).

Read the guide and toolkit, Making every baby count: audit and review of stillbirths and neonatal deaths. This publication assists countries to conduct audits and reviews to recommend and put into action solutions to prevent future stillbirths and neonatal deaths.

Explore Time to respond: a report on the global implementation of maternal death surveillance and response to review the findings of the WHO & UNFPA global survey of national MDSR systems in 2015.


Browse the press release and WHO website to learn more about these three tools, including related papers by the BJOG.

Read this Lancet commentary about all three publications.

Explore this photo story to learn more about MDSR implementation in ten countries around the world.

View this infographic about improving data to learn about what the WHO is doing to help countries save mothers’ and babies’ lives.

Do you know how many women each day experience a stillbirth worldwide? Browse this infographic on the tragedy of stillbirths to find out how many, and more!

Perinatal death audits in a peri-urban hospital in Kampala, Uganda

This paper by Nakibuuka et al (2012), published in the African Health Sciences journal, reports a retrospective descriptive study conducted from March to November 2008 to determine what effect an integrated perinatal death audit system in routine care would have on perinatal mortality at Nsambya Hospital. Modifiable factors that cause stillbirths and early neonatal deaths were: Low capacity of neonatal resuscitation, incorrect use of partographs and delays in administering caesarean sections. Interventions to offset these factors include training sessions in neonatal resuscitation and refresher courses on partograph use. Nakibuuka and colleagues conclude that perinatal audits are feasible and can reduce perinatal mortality at the facility level.

The WHO application of ICD-10 to deaths during the perinatal period: ICD-PM

This is the first publication to help countries strengthen their data on maternal and neonatal deaths, and stillbirths that the WHO launched in August, 2016. This report presents a standardised system that enables the accurate capture and categorisation of stillbirths and neonatal deaths around the world. The ICD-PM is meant to guide those assisting healthcare providers and those tasked with death certification to accurately classify perinatal deaths.

Three distinct features of the ICD-PM are worth noting:

  • It captures the time of the perinatal death – either before, during or seven days after labour
  • It applies a multi-faceted approach to categorising the cause of death
  • It links a perinatal death to the mother’s condition (e.g. diabetes or hypertension), even if there is no condition to report. This feature aligns with the recommendation of the Every Newborn Action Plan to capture maternal complications with the registration of a perinatal death

The report includes tools and classification codes to facilitate consistent reporting. This is the first time that all stillbirths, and neonatal and maternal deaths can be consistently classified across all low-, middle- and high-income settings.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Making Every Baby Count: Audit and review of stillbirths and neonatal deaths

This second publication – launched by the WHO in August, 2016 – aims to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document provides guidance on the review and investigation of perinatal deaths to recommend and put into action solutions to avoid future cases of similar causes. The guide and tools have been developed to be used at multiple levels of a health system from a few individuals at a health facility to a national programme. The tools offer a simpler version of the WHO application of ICD-10 (ICD-10) to deaths during the perinatal period (ICD-PM) to be used in low-resource settings to help initiate and build up audit (or review) systems.

Moreover, the guide integrates elements of the ICD-PM classification system to carry out an in-depth review of the causes and factors leading to all stillbirths and neonatal deaths.

The structure of the guide provides an overview of the key components to develop an audit system by:

  • justifying the purpose of the guide and development of an audit system
  • discussing the issues around defining and categorising causes of death, and providing examples of differing systems to classify preventable causes of deaths and near misses
  • defining six necessary approaches to set up and complete an audit cycle at the facility level
  • describing how to integrate community deaths into an established facility-based audit system
  • promoting a supportive atmosphere for the success of an audit system and giving advice on how to create an enabling environment
  • providing guidance on how to extend an audit system to a regional or national level as well as strengthening links to civil registration and community surveillance systems

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Time to Respond: a report on the global implementation of maternal death surveillance and response

This is the third publication that the WHO launched in August 2016 to help countries improve their data on maternal and neonatal deaths, and stillbirths. This document presents the findings of a global survey conducted by the WHO and UNFPA to determine the status of MDSR implementation in countries where there is a national system.

The report helps countries improve their review process for maternal deaths at the facility level (hospitals and clinics). It also gives guidance for developing a safe environment (free of blame) for healthcare providers to improve the quality of care at facilities. Lastly, it offers an approach to capture deaths taking place beyond the health system (e.g. home births).

The document presents implementation and case study insights, which include identifying barriers to successful systems. The next global survey will take place in 2017 and will be repeated every two years.

Visit the MamaYe-E4A website to read the evidence summary, and to link to the report and other relevant publications.

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

This article by Animesh Biswas and colleagues, published by Health in September 2014, presents findings from a mixed-method study examining the process, feasibility, and acceptance of community death notification in Thakurgaon district, Bangladesh. The study found that community death notification was achievable and acceptable at the district level.

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby

This article by Kate Kerber and colleagues in BMC Pregnancy & Childbirth presents the findings of a review and assessment of evidence for facility-based perinatal mortality audit in low- and middle- income countries, including their policy and implementation status on maternal and perinatal mortality audits.

The authors found that only 17 countries have a policy on reporting and reviewing stillbirths and neonatal deaths despite evidence suggesting that birth outcomes can be improved if the audit cycle is completed. Key challenges in completing the audit cycle and where improvements are needed were identified in the health system building blocks of “leadership” and “health information systems”. Evidence based solutions and experiences from high-income countries are provided to help address these challenges.

The authors conclude that the system needs data mechanisms (e.g. standardised classification for cause of death and best practice guidelines to track performance) as well as leaders to champion the process (e.g. bring about a no-blame culture) and access decision-makers at other levels to address ongoing challenges.